Pain-Free Injections

Tips for parents and children on making vaccinations as easy and pain-free as possible

Vaccines are medicines that protect against infectious diseases. Vaccines are given with a needle, which is painful. Children, their families, and health care providers are often concerned about pain during injections.

Here are some ways pain and anxiety can be reduced during injections.

Preparing yourself in advance

Stay calm

Your actions and words can affect your child’s reaction. Children often look to their parents to understand how to act and feel. If you are calm, use your normal voice, and smile, your child will feel that everything is okay.

Distract your child

Take your child’s attention away from the injection using distraction.

This is effective for children of all ages. Get your child to take slow deep breaths. Children can do this by using bubbles, pinwheels, or balloons, which also distract the child. Other examples of age-appropriate distraction strategies include:

• Babies: toys, pacifiers, singing, directing the baby's attention to something in the room that would be of interest for them
• Toddlers: toys, pop-up books, songs, party blowers, kaleidoscopes, singing, directing the toddler’s attention to something in the room that would be of interest for them
• School-age: toys, stories, videos, books, joking, counting
• Adolescents: games, videos, books, joking, music, talking about something unrelated to the procedure

When talking to your child, avoid words that focus attention on the procedure, such as "hurt," "pain," or "shot." Avoid reassuring words such as "It’ll be over soon" or "You’ll be okay." Avoid apologizing or empathizing, for example "I’m sorry you have to go through this" or "I know it hurts."

Instead, talk about things that have nothing to do with the injection.

Provide physical comfort

Have your child sit upright. Hold babies and young children in a position that is most comfortable for them, for example, on your lap in a bear hug. Hugging feels comfortable and helps children to stay still. Sit on a chair or stand against the examination table to minimize the risk for accidental falls.

Firmly hold your child if necessary but do not use force; this increases distress. In older children, hold hands or offer to stroke or rub their arm before and during vaccine injections.

Plan to use other pain-relieving interventions

Breastfeed your baby

You can breastfeed your baby before, during, and after vaccine injections.

Give sugar water to your baby

If your baby cannot be breastfed, then consider giving sugar water. Mix 1 packet of sugar (the kind you put in your coffee or tea) with 2 teaspoonfuls (10 mL or about a half an ounce) of water. Put some in your baby’s mouth with a cup or pacifier right before the vaccine injection.

Do not use sugar at home to calm upset or crying babies. It is only for managing pain from medical procedures.

Use topical anaesthetics

Topical anaesthetics are pain-relieving creams that are applied to the skin. They can be used in children of all ages. They are particularly useful for school-age children who are anxious.

Several products are available in Canada without a prescription, including EMLA (lidocaine-prilocaine) and Ametop (amethocaine). They must be applied 30 to 60 minutes before the injection.

Before using these creams, make sure your child is not allergic to any of the ingredients. Follow the instructions carefully, being careful to apply them to the correct location and for the correct amount of time. You may want to talk to your health care professional about how and where to apply the cream. Topical anaesthetics can cause temporary discoloration of the skin where they are applied. If you notice a rash, it could be a sign of an allergic reaction. Tell your health care professional.

Preparing your child

Talk to your child about the procedure using age-appropriate words.

In general, tell young children under 4 years old immediately before the procedure. Tell older children at least 1 day before the procedure. Involve and listen to your child. Children often have helpful suggestions for how to manage their pain.

Before the procedure, tell your child:

• The reason for the procedure. For example, "to help you stay healthy."
• What will happen. For example, "You will get a medicine called a vaccine in the arm using a tube that looks like a straw called a syringe."
• How it will feel. For example, "You might feel a pinch and some pushing or pressure that will last a few seconds."
• What you are going to do about their possible discomfort. For example, "Some children think it is uncomfortable and some think it is okay. We don’t know how it will feel for you. We are going to do different things so that it does not feel as uncomfortable for you." Then tell your child what you will do.
• What they can do to help. For example, "You can help by holding still and breathing deeply with me."

Preparing your health care professional

Let your doctor or nurse know what pain management strategies you are planning for your child’s vaccine injections and try to enlist their support. Show them this information sheet.

Ask them to make vaccine injections less painful in the following ways:

• Give intramuscular vaccines quickly without aspiration. Aspiration, in this case meaning pulling back the plunger on a syringe before injecting, is no longer considered a necessary step in vaccine injections.
• Give the most painful vaccine last when more than one vaccine is given in the same visit. There is no rationale for injecting the more painful vaccine first and it increases overall pain.

After the injection, reward your child

After the procedure, praise your child to reinforce their success in getting through the procedure.

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